Open wounds impose serious clinical consequences
Dynamic Action of AbClo
1. Unlike static devices, dynamic therapeutic tension rapidly addresses the challenge of the open abdomen. AbClo’s therapeutic tension addresses the inertia required to return wound edges back to their original position for definitive primary closure.
2. How? Cyclic stretching of tissue decreases muscle atrophy and facilitates re-approximation of the abdominal wall fascia.
3. AbClo can be applied and managed by healthcare professionals at the bedside: no need to take the patient to the OR
Costs of Failing to Achieve Closure
Patients that fail to achieve primary closure cost on average $150,000 more than those tha t are closed primarily
3x Complication Rate
6x Length of Stay
2x Number of Surgical Procedures
Early primary fascial closure provides a better outcome
Indication for Use:
• Support and stabilize the abdominal wall
• Prevent loss of domain
• Prevent abdominal fascia damage
• Prevent lateral retraction of abdominal wall fascia
• Facilitate primary closure of abdominal wall fascia
AbClo Abdominal External
2x Rectus Muscle Splint (RMS) | 1x Circumferential Dynamic | Retainer (CDR)
Results at a Glance
Open Abdominal Wounds
AbClo Abdominal “EXTERNAL” System facilitates early fascial closure of mid-line abdominal defects.
Application of the AbClo System prevents lateralization of the fascial margin by engaging the abdominal wall muscles and applying a gentle, unrelenting dynamic appositional force. AbClo gradually reapproximates the fascial edges preventing damage to the skin and abdominal wall fascia. It is beneficial for primary fascial closure.
Closure of the abdominal wall fascia restores normal physiology, which in certain cases has been shown to reduce length of stay, short term morbidity risks and future health costs
Case Studies
Trauma & Stoma
Patient
Information
- 41 year-old-male,
- gunshot wound to the abdomen; BMI 31.1 Kg/m2.
- On arrival at the Trauma Center, patient was awake, hypotensive.
- Chest X-ray: Pneumothorax(R) (chest tube placed) .
- Pelvic X-ray: Bullet in Pelvis.
- Fast ultrasound showed positive abdominal fluid.
- Massive transfusion protocol (MTP) active & Tranexa (TXA).
- Patient taken to the Operating Room (OR).
Operative
Management
- Injuries: Expanding retroperitoneal pelvic hematoma, perforated cecum and right colon.
- Initial Damage Control procedures: Vascular exploration of pelvic vessels; right hemicolectomy (left in discontinuity); packing of non-surgical bleed in the pelvis.
- Fluid Status: ◦ +15L crystalloids + Vasopressors ◦ 5U packed red blood cells (PRBC) + 2U fresh frozen plasma (FFP)
- “Open Abdomen” with Abthera (For a Logistic reason)
- Interventional Radiology
Case
Challenges
- Cumulative Fluid Balance (+10.2L) on day of closure.
- Ileostomy
Solution:
◦ AbClo placement was delayed by 24h. Proper orientation to place AbClo as soon as possible after the abdomen is left open.
Adversity:
◦ Primary Fascial Closure on Post-Op day #6 on the second take back. Consistent Gradual decrease of the fascial defect with AbClo over the post-operative period. AbClo placed at the bedside; Fascia and Skin undamaged. Only one AbClo was used throughout the entire treatment.
@ 24h
Post-operative day 6
After closure day 7
Case Studies
Acute Care Surgery & Elderly Stoma
Patient
Information
- 80 year-old female,
- Chronic renal failure (failed renal transplant);
- Generalized peritoneal signs; BMI 32.8 Kg/m2.
- CT abdomen: Free air, Free fluid, perforated sigmoid colon.
- Patient in septic shock, on pressors.
- Patient taken to the Operating Room (OR)
Operative
Management
- Findings: Perforated sigmoid (diverticulitis) and diffuse peritonitis.
- Initial Damage Control procedures: Sigmoidectomy; descending colon left in discontinuity and rectal stump closed.
- Fluid Status: ◦ +2L crystalloids + Vasopressors
- “Open Abdomen” with Abthera + AbClo (Logistic and physiologic reasons).
- ICU
Case
Challenges
- Chronic renal failure (failed kidney transplant).
- Hartmann’s procedure
Adversity:
◦ None
Solution:
◦ Primary Fascial Closure on Post-Op day #3 after 1 take back. Consistent decrease and maintenance of the fascial defect reduction with AbCLO over the post-operative period.
AbClo placed at the bedside; Fascia and Skin undamaged. Only one AbClo was used throughout the entire treatment.
At the end of first operation
After initial AbClo Placement at Bedside in ICU
After Primary fascial Closure
Case Studies
BMI 60.9Kg/M2 + Rectal and Small Bowel Perforation
Patient
Information
- 45 year-old-female,
- Post-operative complication of right oophorectomy and bilateral salpingectomy for dermoid cyst;
- BMI 60.9 Kg/m2.
- On arrival at ER: Patient awake, hypotensive, peritonitic, signs of septic shock.
- Abdominal CT scan: Free fluid and air, pelvic collection, distended bowel loops.
- Fluid resuscitation and antibiotics.
- Patient taken to the Operating Room (OR)
Operative
Management
- Initial attempt at laparoscopy caused a trocar injury to a small bowel loop.
- Initial Damage Control procedures: resection of injured small bowel and suture of rectal injury from gynecological procedure.
- Fluid Status: +14.3L crystalloids + Vasopressors
- 2U packed red blood cells (PRBC)
- “Open Abdomen” with Abthera indications (Logistic + Physiologic + Anatomic)
- ICU Management
Case
Challenges
- BMI 60.9Kg/M2
- Anastomotic Leak
- No attempt to close fascia primarly
Adversity:
◦ None
Solution:
◦ No attempt to close the fascia; Vicryl Mesh to bridge the defect on Post-Operative day #10. Anastomotic leak detected post op day #8. Gradual decrease of the fascial defect and maintenance of the reduction with AbCLO over the post-operative period despite BMI 60.9Kg/M2. AbClo moved ALL LAYERS of the abdominal wall despite BMI of 60.9Kg/M2.
